Value Of Lung Ultrasound And Serum Level Of Brain Natriuretic Peptide In Diagnosis Of Asymptomatic Pulmonary Congestion Among Saudi Pediatric Hemodialysis Patients

Abstract

Background: Depending on clinical assessment, determining the ideal dry weight (DW) to minimize volume overflow in hemodialysis (HD) patients is imprecise since hypervolemia symptoms appear only when severe dehydration occurs. Objective: To evaluate the diagnostic accuracy of serum level of brain natriuretic peptide (BNP) and its correlation with lung ultrasound (LUS) in detecting the presence of asymptomatic pulmonary congestion as a sign of residual v[1]olume overload in HD patient. Patients and Methods: A prospective observational study was conducted on 20 HD pediatric patients with asymptomatic pulmonary manifestation who underwent LUS and BNP leveling before and after HD session, LUS was                      considered positive when B-line score (BLS) >10. Volume load parameters were also evaluated before and after HD. Results: the reduction in mean BNP after HD session was significant as BNP levels reduced from (219.5±67.802) pg/ml to (116.75±50.772) pg/ml, with significant positive correlation between post-dialysis BNP and BLS (p< 0.001, r 0.914). Conclusion: LUS lung congestion was present in a large number of patients who were clinically euvolemic, without clinical signs of overhydration, and who were deemed to be at goal DW at the end of the HD session. This implies that a patient can continue to experience residual volume overload even after reaching their purported goal DW. In the event that LUS is not an option, BNP leveling might be useful.